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001-es BibID:
BIBFORM010426
Első szerző:
Serruys, Patrick W.
Cím:
Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease / Patrick W. Serruys, Marie-Claude Morice, A. Pieter Kappetein, Antonio Colombo, David R. Holmes, Michael J. Mack, Elisabeth Stähle, Ted E. Feldman, Marcel van den Brand, Eric J. Bass, Nic Van Dyck, Katrin Leadley, Keith D. Dawkins, Friedrich W. Mohr, The SYNTAX Investigators
Dátum:
2009
ISSN:
0028-4793 (Print)
Megjegyzések:
Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS: We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry. RESULTS: Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003). CONCLUSIONS: CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year.
Tárgyszavak:
Orvostudományok
Klinikai orvostudományok
idegen nyelvű folyóiratközlemény külföldi lapban
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cardiovascular Diseases
Coronary Artery Bypass
Coronary Artery Disease
Drug-Eluting Stents
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Infarction
Prospective Studies
Retreatment
numerical data
Severity of Illness Index
Stroke
Treatment Outcome
Megjelenés:
The New England Journal of Medicine. - 360 : 10 (2009), p. 961-972. -
További szerzők:
Morice, Marie-Claude
Kappetein, Arie Pieter
Colombo, Antonio
Holmes, David R.
Mack, Michael J.
Stähle, Elisabeth
Feldman, Ted E.
Brand, Marcel, van den
Bass, Eric J.
Dyck, Nic, Van
Leadley, Katrin
Dawkins, Keith D.
Mohr, Friedrich Wilhelm
Édes István (1952-) (kardiológus)
The SYNTAX Investigators
Internet cím:
DOI
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